#Diabetes

Study Links Diet, Diabetes, and Alzheimer’s

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Summary: A new study explores the molecular connections between Type 2 diabetes and Alzheimer’s, supporting the notion of Alzheimer’s as “Type 3 diabetes.”

This study finds that a high-fat diet suppresses a crucial gut protein, Jak3, leading to Alzheimer’s-like brain changes in mice. It underscores the importance of managing diabetes or avoiding it through diet to reduce Alzheimer’s risk.

The findings illuminate a potential path from diet through gut inflammation to brain health, offering hope for preventative strategies.

Key Facts:

  1. Molecular Connection: The suppression of the Jak3 protein in the gut due to a high-fat diet can initiate a cascade of inflammation leading to Alzheimer’s-like symptoms in the brain.
  2. Preventative Potential: Controlling or avoiding diabetes through diet and blood sugar management could significantly reduce the risk of developing Alzheimer’s disease.
  3. Broad Implications: Given the vast number of U.S. adults with prediabetes, lifestyle changes to prevent diabetes may also mitigate Alzheimer’s risk, highlighting the critical intersection of diet, metabolic health, and neurodegeneration.

Source: ASBMB

New research conducted in mice offers insights into what’s going on at the molecular level that could cause people with diabetes to develop Alzheimer’s disease.

The study adds to a growing body of research on the links between Type 2 diabetes and Alzheimer’s disease, which some scientists have called “Type 3 diabetes.”

The findings suggest that it should be possible to reduce the risk of Alzheimer’s by keeping diabetes well controlled or avoiding it in the first place, according to researchers.

This shows vegetables.
To find out how diet could influence the development of Alzheimer’s in people with diabetes, the researchers traced how a particular protein in the gut influences the brain.

Narendra Kumar, an associate professor at Texas A&M University in College Station, led the study.

“We think that diabetes and Alzheimer’s disease are strongly linked,” Kumar said, “and by taking preventative or amelioration measures for diabetes, we can prevent or at least significantly slow down the progression of the symptoms of dementia in Alzheimer’s disease.”

Kumar will present the new research at Discover BMB, the annual meeting of the American Society for Biochemistry and Molecular Biology, which is being held March 23–26 in San Antonio.

Diabetes and Alzheimer’s are two of the fastest-growing health concerns worldwide. Diabetes alters the body’s ability to turn food into energy and affects an estimated 1 in 10 U.S. adults. Alzheimer’s, a form of dementia that causes progressive decline in memory and thinking skills, is among the top 10 leading causes of death in the United States.

Diet is known to influence the development of diabetes as well as the severity of its health impacts. To find out how diet could influence the development of Alzheimer’s in people with diabetes, the researchers traced how a particular protein in the gut influences the brain.

They found that a high-fat diet suppresses the expression of the protein, called Jak3, and that mice without this protein experienced a cascade of inflammation starting with the intestine, moving through the liver and on to the brain.

Ultimately, the mice showed signs of Alzheimer’s-like symptoms in the brain, including an overexpressed mouse beta-amyloid and hyperphosphorylated tau, as well as evidence of cognitive impairment.

“Liver being the metabolizer for everything we eat, we think that the path from gut to the brain goes through liver,” Kumar said.

His lab has been studying functions of Jak3 for a long time, he added, and they now know that the impact of food on the changes in the expression of Jak3 leads to leaky gut. This in turn results in low-grade chronic inflammation, diabetes, decreased ability of the brain to clear its toxic substances and dementia-like symptoms seen in Alzheimer’s disease.

The good news, according to Kumar, is that it may be possible to stop this inflammatory pathway by eating a healthy diet and getting blood sugar under control as early as possible.

In particular, people with prediabetes — which includes an estimated 98 million U.S. adults — could benefit from adopting lifestyle changes to reverse prediabetes, prevent the progression to Type 2 diabetes and potentially reduce the risk of Alzheimer’s.

How do I cure diabetes without medicine?

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The idea of curing diabetes without medication is a complex subject and depends greatly on the type of diabetes as well as individual health factors. For Type 1 diabetes, an autoimmune condition where the pancreas produces little to no insulin, there is currently no cure, and treatment must include insulin therapy. However, with Type 2 diabetes, characterized by insulin resistance and often related to lifestyle factors, significant lifestyle changes can sometimes lead to remission, which means blood sugar levels are stable in a normal range without medication. Let’s explore potential strategies to manage type 2 diabetes through lifestyle adjustments:

  • Dietary Changes:
    • Low-Carbohydrate Diet: Restricting carbohydrate intake can help reduce blood sugar spikes.
    • Fiber-Rich Foods: Incorporating a high-fiber diet can improve glycemic control.
    • Glycemic Index: Choosing foods with a low glycemic index may help maintain steady blood sugar levels.
    • Whole Foods: Emphasizing whole, minimally processed foods can support overall metabolic health.
  • Physical Activity:
    • Routine Exercise: Engaging in regular physical activity increases insulin sensitivity, which means your body can use insulin more effectively to lower blood sugar.
    • Resistance Training: In addition to aerobic exercise, resistance training can build muscle, which in turn improves blood sugar utilization.
  • Weight Management:
    • Maintaining a Healthy Weight: Excess body fat, particularly visceral fat around the abdomen, is linked to increased insulin resistance.
    • Weight Loss: For those who are overweight, losing even a modest amount of weight (5–10%) can significantly improve diabetes control and may lead to remission.
  • Behavior Modification:
    • Mindful Eating: Being mindful of hunger and fullness cues can help prevent overeating.
    • Stress Management: Practice stress-reduction techniques such as meditation, yoga, or deep breathing exercises, as chronic stress can raise blood sugar levels and insulin resistance.
  • Sleep Hygiene:
    • Consistent Sleep Schedule: Prioritizing quality sleep can affect glucose metabolism and hormone regulation.
    • Adequate Sleep Duration: Ensuring 7-9 hours of sleep per night can support overall health and help manage diabetes.
  • Regular Monitoring:
    • Blood Sugar Tracking: Frequent monitoring of blood sugar levels can help you understand how diet, exercise, and other factors influence your condition.
  • Community and Support:
    • Support Networks: Joining diabetes support groups for advice, sharing experiences, and emotional support can be beneficial.
    • Professional Guidance: Consult with healthcare providers, including dietitians who specialize in diabetes, for personalized care plans.
  • Potential Role of Dietary Supplements:
    • Certain supplements may improve insulin sensitivity or blood sugar control, but they should never replace conventional treatment without a discussion with a healthcare provider.
  • Holistic Approaches:
    • Integrating holistic and complementary therapies, like acupuncture or herbal remedies, may provide additional support but need to be validated by healthcare professionals for their safety and efficacy.
  • Understanding Remission vs. Cure
    • It is important to differentiate between ‘curing’ diabetes and achieving’remission.’ Remission implies that the disease is being managed successfully without the need for medication, but the potential for its return remains if lifestyle changes are not maintained.

Achieving diabetes remission through lifestyle changes is a significant challenge and cannot be guaranteed for everyone. Complete, long-term remission where blood sugar levels remain permanently normal without any treatment is rare. Even with a dedicated lifestyle overhaul, some individuals with type 2 diabetes will still require medication to maintain normal blood sugar levels. It’s essential to make these changes under the supervision of a healthcare provider to ensure safe and effective diabetes management.

SOURCE: QUORA

Can Honey Fight Diabetes?

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Although honey contains a significant amount of sugar, it differs from regular sugar.

In this series, we will explore the good and bad sweeteners, uncover the unexpected outcomes of cutting out sugar, and discover the ultimate way to achieve this.

Currently, most health organizations, including the World Health Organization and the U.S. Food and Drug Administration, still classify honey as either free sugar or added sugar. Although honey contains a significant amount of sugar, it differs from regular sugar. Numerous studies and experts have indicated that honey may benefit metabolism, specifically by reducing blood sugar levels.

Types of Sugars Found in Honey

Honey is a delightful gift from nature. With variations based on the source plants and other factors, there are more than 300 types of honey worldwide.

In general, honey is made up of about 17 percent water, and 95 to 99 percent of the remaining dry matter is sugar. Among these sugars, the major components are fructose and glucose. On average, 100 grams of honey contains approximately 38.5 grams of fructose and 31 grams of glucose.

Notably, 14 percent of the sugars in honey are rare sugars, many of which are formed during the maturation process of honey. These rare sugars are uncommon in nature and are believed to have beneficial health effects.

“Honey should not be categorized as free sugar. It is different,” Tauseef Khan, a research associate in the Department of Nutritional Sciences at the University of Toronto’s Temerty Faculty of Medicine, told The Epoch Times.

Mr. Khan said honey is a “complex mixture of sugars” and that rare sugars, which have unique benefits, aren’t complex carbohydrates but are usually found in the form of monosaccharides or disaccharides. These sugars possess potential metabolic effects, and many also serve as prebiotics.

Compared with regular sugar, honey can lower fasting blood sugar levels, reduce bad cholesterol, and raise good cholesterol

“Those effects are very surprising; if it was normal sugar, then those effects should not have been there,” Mr. Khan said.

In a statement discussing the discovery that honey can reduce cardiometabolic risk, John Sievenpiper, associate professor of nutritional sciences and medicine at the University of Toronto, said: “The word among public health and nutrition experts has long been that ‘a sugar is a sugar.’ These results show that’s not the case.”

Sweeter Than Sugar but Has a Lower Glycemic Index

The glycemic index (GI) (pdf) of glucose is 100, while sucrose averages about 66 and fructose 24. Because of variations in sugar composition, the GI values of different types of honey fall within the range of 35 to 74, with an average of 60.

Interestingly, because of its high level of fructose, honey is 25 percent sweeter than sugar.

Nevertheless, honey has lower GI values and calorie content than refined sugar.

Fructose has a bad reputation that may be unwarranted. Researchers at the University of Toronto published a study in The American Journal of Clinical Nutrition reviewing 169 clinical trials related to fructose. The study concluded that naturally occurring fructose found in fruits and honey isn’t likely to contribute to weight gain and may even positively affect weight loss. Another review study published in Molecules indicated that fructose in honey may slow intestinal absorption, prolong gastric emptying, and reduce food intake. Fructose in honey was found to enhance the liver’s metabolic capacity for glucose.

Honey’s Proven Anti-Diabetic Effects

Using honey as a substitute for refined sugar in one’s diet offers additional benefits.

The blood sugar-lowering and anti-diabetic effects of honey have been proven in both animal and human studies.

In a 2008 study, 55 overweight or obese people were divided into two groups, with one group receiving a daily intake of 70 grams of sucrose and the other receiving 70 grams of honey, both for 30 days. The results show that compared with the pre-intervention period, the group consuming honey experienced a 4.2 percent decrease in fasting blood sugar levels and improved insulin resistance. Honey also resulted in a slight reduction in body weight and body fat percentage by 1.3 percent and 1.1 percent, respectively, alongside a 3 percent decrease in total cholesterol, an 11 percent decrease in triglycerides, and a 3.3 percent increase in good cholesterol.

On the other hand, people who received sucrose experienced different changes. Not only did their fasting blood sugar levels rise by 2.2 percent, but their body weight and body fat percentage also increased.

According to a controlled experiment published in 2017, healthy adults who replaced 25 percent of their dietary carbohydrates with honey for eight consecutive days experienced decreased postprandial (post-meal) insulin and blood sugar levels.

Replacing carbohydrates with honey results in decreased postprandial blood sugar and insulin levels. (The Epoch Times)
Replacing carbohydrates with honey results in decreased postprandial blood sugar and insulin levels. (The Epoch Times)

In another experiment comparing honey and glucose effects on diabetic and healthy people, healthy subjects were given an equal quantity of honey or glucose. The results revealed that honey intake resulted in significantly smaller fluctuations in blood sugar and insulin levels than glucose consumption. After consuming honey for 15 consecutive days, healthy people experienced an average 6 percent decrease in blood sugar levels compared with before honey consumption. Diabetic patients also exhibited noticeably smaller changes in blood sugar levels when consuming honey instead of glucose.

Healthy people experienced smaller fluctuations in blood sugar levels when consuming honey, while diabetic patients exhibited smaller changes in blood sugar levels with honey intake. (The Epoch Times)
Healthy people experienced smaller fluctuations in blood sugar levels when consuming honey, while diabetic patients exhibited smaller changes in blood sugar levels with honey intake. (The Epoch Times)

In a long-term intervention trial conducted in Egypt, 20 participants diagnosed with diabetes drank honey water, prepared by dissolving 50 milliliters (three tablespoons) of honey in water, on an empty stomach twice per day before meals. They consumed an additional 25 milliliters of honey as the sole sweetener in their diets.

During the trial, none of these patients experienced diabetic ketoacidosis or hyperglycemic hyperosmolar state (common symptoms include dry skin or tongue, fruity breath, drowsiness, confusion, difficulty breathing, rapid heartbeat, abdominal pain, and vomiting). Long-term consumption of honey led to weight reduction, controlled blood pressure, and improved cardiovascular conditions in all patients.

A 2018 review study published in Oxidate Medicine and Cellular Longevity revealed that honey has beneficial effects on diabetes, a complex disease. Compared with sugar, consuming honey can reduce weight and lower blood sugar levels in healthy people and patients with diabetes. A systematic review and meta-analysis published in Nutrition Reviews in 2022 also affirmed the positive effects of honey on blood sugar and metabolism.

How Does Honey Control Blood Sugar?

How can honey lower blood sugar levels, despite being a type of sugar?

Mr. Khan said honey contains 30 to 40 different types of rare sugars, which play a role in regulating appetite-related hormones and insulin secretion, ultimately promoting glucose metabolism.

These rare sugars can help mitigate the effects of fructose and glucose, resulting in lower fasting blood sugar levels and improved blood sugar control. Some of them also serve as food for certain good bacteria, which are beneficial for gut health, while others have immune-enhancing properties.

The compounds and flavonoids found in honey possess antioxidant properties that can improve the progression of diabetes caused by oxidative stress and metabolic disorders associated with the condition. Interestingly, the antioxidant capacity of honey is associated with its color, with darker honey having a higher antioxidant value.

The trace elements found in honey, such as zinc and selenium, are also believed to contribute to blood sugar control.

Specific proteins present in honey can activate the body’s innate immune system.

Hair Loss and Diabetes

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Hair loss is a common condition affecting millions of people each year. Hair loss occurs for a variety reasons. Diabetes is one of them.

One of the lesser-known effects of fluctuating blood sugar levels is losing hair all over the body. Understanding and acknowledging the relationship between diabetes and hair can help you handle the issue effectively. This article will explore the connections between hair loss and diabetes.

When Should You Worry About Hair Loss?

According to the American Academy of Dermatology (AAD), adults lose about 50 to 100 strands of hair a day, which is to be expected. AAD calls this hair shedding, which is different from hair loss. 

Hair loss occurs when there is excessive hair shedding. Here are some signs that may tell you that you could be losing hair. 

  • Visibly receding hairline
  • The appearance of bald patches
  • Widening center or side partitions
  • Unusually increased hair fall
  • Hair falling out in clumps
  • A noticeable reduction in hair thickness or density

While hair loss is a natural part of aging (for both men and women), you’ll probably know when your hair loss has accelerated to an unexpected level.

How Diabetes Causes Hair Loss

Diabetes mellitus can affect every part of the body, including the hair follicles. The relationship between diabetes and hair loss is complex and multifaceted.

Unfortunately, there’s not much data on the prevalence of diabetes-related hair loss. One academic survey suggests that African American women with diabetes could have a 68 percent increased risk of severe hair loss in the central scalp area, though these results were based only on self-reported responses to an online questionnaire.  

Here are different ways in which this chronic condition affects hair.  

Poor blood circulation 

The hair follicles need oxygen-rich blood flow to grow. Chronic hyperglycemia (high blood sugar levels) will damage blood vessels, including those carrying blood to the hair follicles. This, in turn, will disrupt hair regrowth and lead to shedding. A 2016 article suggests that uncontrolled diabetes leads to diffuse hair loss, characterized by hair thinning and low hair density. 

In fact, your blood sugar concentrations affect hair so directly that your hair preserves evidence of your recent blood glucose history. Some researchers have even proposed using chemical analysis of hair to improve upon a traditional A1C measurement.

Diabetes-induced vascular damage can make you lose hair in other parts of the body, like in the legs or the arms. Losing hair in the extremities could be a definite sign of high blood sugar levels, which should be addressed immediately.

The diabetes -autoimmune relationship

People with type 1 diabetes frequently experience additional autoimmune conditions. One interest here is alopecia areata (AA). According to Everyday Health, AA is a condition where the body’s immune system attacks the hair follicles, leading to hair loss. 

A 2013 study analyzed the prevalence of AA in 3,568 individuals between 2000 and 2011. According to this study, 11.1 percent of individuals with AA also had type 1 diabetes. If you have type 1 diabetes and experience an itchy, tingly scalp with hair falling out in clumps, talk to your healthcare provider so they can test you for this autoimmune condition.  

Use of certain diabetic medications

Certain diabetic medications may encourage excess hair loss. In particular, dipeptidyl peptidase 4 (DPP-4) inhibitors have been associated with hair loss and alopecia in case reports. 

Semaglutide (Ozempic), the diabetes drug the world’s raving about, reportedly causes hair loss. Ozempic controls type 2 diabetes by increasing insulin secretion, reducing appetite, and promoting weight loss. While semaglutide doesn’t directly affect the hair follicles, the dramatic weight loss can cause hair loss due to a condition named telogen effluvium. The metabolic stress of rapid weight loss leads to thinning hair, but thankfully, Ozempic-induced hair loss appears to be temporary.

Other medications commonly taken by people with diabetes are also associated with hair loss, including medications for hypertension, high cholesterol, gout, and depression.

Interestingly, some studies say that metformin, one of the most commonly used medications for treating type 2 diabetes, may actually be beneficial in promoting hair follicle regeneration and helping individuals with male or female pattern hair loss. 

The diabetes -thyroid relationship 

Did you know that there is a relationship between diabetes, thyroid dysfunction, and hair loss? People with diabetes, particularly type 1 diabetes, have a higher risk of developing both hyperthyroidism and hypothyroidism. 

These thyroid conditions are strongly associated with hair loss. According to a 2023 study, 33 percent of people with hypothyroidism and 50 percent of people with hyperthyroidism may experience excessive hair shedding.

Diabetes-induced iron deficiency 

There is a positive correlation between higher A1C levels and iron deficiency. Iron deficiency, on the other hand, directly contributes to both androgenetic alopecia (pattern baldness) and telogen effluvium (excessive hair shedding due to stress).

Polycystic ovarian syndrome (PCOS)

PCOS may affect as many as 10 percent of women during their reproductive years. It shares a common cause with type 2 diabetes — insulin resistance — and the two conditions often coexist.

Polycystic ovarian syndrome is generally characterized by an excess of androgen, a family of sex hormones associated with masculinity, including testosterone. When women secrete too much testosterone, hair thinning is a common side effect, along with facial hair growth, weight gain, and irregular periods. There is no cure for PCOS, but doctors can use many medications to help manage its diverse symptoms, including hair loss.

Mental health challenges

We all agree that managing a chronic condition like diabetes can get challenging. People with diabetes have a higher risk of developing diagnosable mental health issues like depression and anxiety, or of experiencing diabetic distress.

These mental health conditions can affect the body in different ways, including increasing your stress hormone called cortisol. Higher levels of cortisol reduce the levels of certain proteins needed for the hair follicles to function well, causing hair loss. Some studies suggest that stress can also extend the hair resting phase, reducing regrowth. 

Tips to Manage Diabetic Hair Loss

Managing blood sugar levels

If high blood sugars are causing alopecia, stabilizing it as quickly as possible with drugs, diet, and lifestyle changes may help curb and hopefully reverse the condition. 

Early screening for hair loss

If you have type 1 or type 2 diabetes, speaking to a doctor can help you understand what’s your ‘normal’ hair loss. If you think you are suddenly losing a lot of hair, spotting bald patches, or finding an unexplained reduction in hair density, early screening will help identify the root cause and get preventive measures in place.

Medications

There are many medications approved to treat hair loss.

Minoxidil is an FDA-approved topical medication that may help in hair regrowth. Minoxidil also comes in a pill — in this form, it is only approved as a therapy for hypertension, but some doctors prescribe it off-label to help with hair loss.

Corticosteroids (oral, injectibles, and topical) are commonly used in treating AA. However, there is a risk of steroids causing or worsening hyperglycemia, which may make them less appropriate for people with diabetes.

Other medications that may be used to treat hair loss include:

  • Birth control pills that contain estrogen can help address androgenetic alopecia.
  • Spironolactone (topical and oral applications) to treat both male and female androgenic alopecia.
  • Finasteride (5-alpha reductase inhibitor for male pattern baldness).
  • Dutasteride (for male hair loss)

Dietary supplements

There is a strong connection between diabetes and nutritional deficiencies, which studies may cause changes in hair structure and affect hair regrowth.  

Metformin can cause vitamin B12 deficiency, which can lead to hair loss. Low vitamin D levels, which are common in people with types 1 and 2 diabetes, may also contribute to hair loss. It is possible that dietary supplements could help address these deficiencies.

Aesthetic solutions 

A more direct approach is to adapt your look to hide hair loss. Everyday Health recommends experimenting with coverings, including wigs, scarves, and hats, or using other cosmetics to camouflage hair loss. A new haircut or hairstyle could help, as well as clip-in extensions and wiglets.

Platelet-rich plasma (PRP) is a treatment in which your own blood is collected, refined, and injected directly into the skin along the scalp. This refined blood is especially rich in platelets, which secrete growth factors that can act directly on hair follicles, stimulating hair growth. PRP is used specifically to treat androgenetic alopecia.

Finally, hair transplant surgery is always a solution to permanent balding or excessive hair shedding. 

Takeaways

Diabetes is one of many factors that can contribute to excessive hair shedding. There are no easy answers, but optimal blood sugar control, good nutrition, and stress reduction can all help curb hair loss and may even promote new hair regrowth. While you concentrate on getting your diabetes management under control, a doctor can also recommend medications that may help your scalp, and there are many aesthetic solutions available, from wigs to hair transplant surgery.

Denosumab Protective Against Diabetes?

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Study found lower diabetes incidence with osteoporosis drug for patients who stayed on treatmentShare on Facebook. Opens in a new tab or window

A photo of a Prolia auto injector

Continued treatment with the osteoporosis drug denosumab (Prolia) was tied to a lower risk of developing diabetes in a Taiwanese cohort study.

In a propensity score-matched analysis, adherence to denosumab for osteoporosis was associated with a 16% lower risk for incident diabetes compared with cessation after the first dose (HR 0.84, 95% CI 0.78-0.90), Edward Chia-Cheng Lai, PhD, of National Cheng Kung University in Taiwan, and colleagues reported in JAMA Network Openopens in a new tab or window.

Stratification by age, however, showed the findings to be entirely driven by patients 65 and up:

  • Age 65 and over: HR 0.80 (95% CI 0.75-0.85)
  • Younger than 65 years: HR 1.02 (95% CI 0.83-1.27)

The findings, which had an average follow-up of just under 2 years, suggest a potential dual benefit with denosumab in this population, Lai told MedPage Today, combining the agent’s established role in preventing bone fractures with the potential protection against diabetes.

“This is particularly significant given the increasing prevalence of both osteoporosis and diabetes in the aging population,” Lai said. “Our study suggests that when choosing anti-osteoporosis medication, physicians might also consider the potential benefit of lowering diabetes risk. This could be especially relevant for patients at high risk of diabetes or those with preexisting metabolic conditions.”

While promising, the findings weren’t entirely surprising, he added. “Given the preclinical evidence suggesting that receptor activator of nuclear factor κB ligand (RANKL) signaling inhibition can improve insulin sensitivity and glucose tolerance, we hypothesized that denosumab could have a positive impact on glucose homeostasis,” Lai explained. “It’s rewarding to see clinical data align with preclinical expectations, reinforcing the potential for osteoporosis treatments to have broader metabolic benefits.”

“We hope doctors will recognize the importance of considering the broader health implications of anti-osteoporosis treatments,” said Lai.

Denosumab was first approvedopens in a new tab or window back in 2010 for postmenopausal women with osteoporosis at high risk for bone fracture. The RANKL inhibitor later picked up a number of other indications, including osteoporosis in men, glucocorticoid-induced osteoporosis in either sex, bone loss in men receiving androgen-deprivation therapy for prostate cancer, and bone loss for women receiving aromatase inhibitor therapy for breast cancer. But following an FDA safety alertopens in a new tab or window in November 2022, the agency recently added a boxed warningopens in a new tab or window to the label over the risk of severe hypocalcemia in patients with advanced chronic kidney disease.

Denosumab is also approved under the trade name Xgeva to reduce the risk of bone-related events in certain cancer patients.

A total of 68,510 patients were included in the nationwide, propensity score-matched cohort study. Patient data came from Taiwan’s National Health Insurance Research Database on adults who received denosumab for osteoporosis from 2012 to 2019. Most were female (84.3%) and the average age was 78 years.

The treatment group included 34,255 patients who received their second dose per the anticipated administration schedule 180 days after the initial dose, and the comparison group included 34,255 patients who didn’t receive a second dose.

Half of the patients in each group had a history of vertebral fracture, 15% had a history of hip fracture, and 5% had a history of wrist or humerus fracture.

Incident diabetes was defined as need for a new antidiabetic drug. Over a mean 1.9 years of follow-up, a total of 2,016 denosumab-treated adults developed diabetes versus 3,220 of those who stopped treatment (incidence rates of 35.9 vs 43.6 per 1,000 person-years, respectively).

The lower risk of diabetes associated with denosumab was consistent across sexes and seen regardless of comorbidity status: with or without dyslipidemia, with or without hypertension, with or without ischemic heart disease, and with or without kidney failure.

Other factors such as lifestyle, substance use, prediabetes status, weight, and lab results weren’t available for the patients.

What vegetables should be avoided by a diabetes patient?

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You can’t eat sweets anymore. Never. People with diabetes, have you heard a phrase like that at least once in your life? There is an opinion that if a person is diagnosed with diabetes, his diet in the future will consist exclusively of fresh, tasteless foods. But this is not entirely true, because diet and nutrition for diabetes can be delicious, and the quality of life will only increase. What to expect from a diet with diabetes, how to control glucose levels and learn to count units of bread? The endocrinologist at the San Nicolás Clinic will tell you.

What level of sugar is considered dangerous?

The norm of fasting blood glucose is 3.9 to 5.6 mmol/l. If the analysis results are different, it may mean the following:

Prediabetes: 5.6-6.9 mmol/l. This means that diabetes has not yet developed, but a number of processes are occurring in the body that can increase the risk of its onset.

Diabetes: more than 7 mmol/l. So far there is no special danger to health, if it is detected in time and appropriate measures are taken.

Endocrinology of diabetes mellitus

Next, there are 3 degrees of hyperglycemia:

Light: 6.7-8.2 mmol/l

Average gravity: 8.3-11.0 mmol/l

Heavy: more than 11.1 mmol/l

If the indicators exceed 16.5 mmol / l, precoma develops, and when the concentration of glucose in the blood is above 33.3 mmol / l, hyperglycemic coma. These states are described in more detail below.

Consequences of diabetes

It is not uncommon for people to see a doctor whose sugar level is outside the normal range: 20-25 mmol/l. In addition, they are usually applied in case of typical complaints:

Consultation of an endocrinologist.

Decreased visual acuity up to loss of vision.

Damage to all blood vessels (heart, kidneys, brain, retina)

Impaired kidney function (up to kidney failure)

Gangrene, trophic ulcers of the lower extremities.

Stroke, heart attack

Impotence

hearing impairment

Frequent infections (especially bladder, kidney)

This is due to the fact that with prolonged hyperglycemia, glucose accumulates in the tissues and becomes toxic: it destroys the liver, kidneys, blood vessels, heart and nerve fibers. But not only can high sugar have a harmful effect on the body, hypoglycemia is also dangerous. First of all, the brain suffers, as it consumes up to 60% of all the energy supplied by glucose. As a result, dizziness, weakness, decreased concentration, darkening of the eyes, tremors of the limbs, fainting.

There are also particularly dangerous consequences that require immediate assistance:

Ketoacidosis is a condition that develops when there is a lack of insulin in the blood. As a result, glucose cannot enter the cell, and to obtain the necessary energy, the body begins to break down fatty acids in large quantities. In the process of division, toxic ketone bodies are formed that accumulate in the blood very quickly, so the kidneys do not have time to excrete ketones with urine. As a result, ketoacidotic coma or even death, if timely medical assistance was not provided.

Hyperglycemic coma – an increase in blood glucose level to critical values (above 33.3 mmol / l). A person has intense thirst, a constant urge to urinate, and if no action is taken, he falls into a coma.

Hypoglycemic coma is a critically low blood glucose level (below 1.65 to 1.38 mmol/l). As already mentioned above, the main consumer of glucose is the brain, and if it does not receive enough nutrition, the brain goes into “hibernation” to save energy.

What is the difference between nutrition for type 1 and type 2 diabetes?

Nutrition for type 1 diabetes.

It is important to get all the essential nutrients in the same amount as a normal person. If there is no tendency to satiety, then the daily calorie content of dishes should not differ from the norm. The only thing that is important to know is the amount of carbohydrates in the food. On average, 1 unit of insulin is calculated per 15 g of carbohydrates, the insulin dose is adjusted to the meal, taking into account the number of bread units of the next meal. According to modern recommendations, the most suitable foods for type 1 diabetes are foods from the so-called Mediterranean diet.

Nutrition for type 2 diabetes.

There are no special differences in the diet, the diet should also be saturated with non-starchy vegetables, complex carbohydrates and whole grain products. If you are overweight, your doctor may recommend a low-calorie or low-carbohydrate diet.

Additionally, type 2 diabetics need to consume at least 1.5 liters of water per day.

Recommendations to reduce sugar levels

The basis for maintaining an optimal glucose concentration is a healthy lifestyle and a diabetes-appropriate diet. Usually includes:

Helps with diabetes

Refusal of alcohol

Reduce the amount of sugar and sweeteners.

Replace fast food with homemade dishes

Changing flour products from soft varieties of wheat to hard varieties.

Eat strictly according to schedule (avoid snacks)

Replace unhealthy foods with healthy foods (for example, you can eat frozen smoothie bananas instead of ice cream)

Avoid overeating

TOP-3 diet rules

Replace sweets with healthy food!

Can’t give up sweets with tea? Then, instead of the usual chocolate, it is better to eat a small amount of nuts and whole grain crackers. You like ice cream? Try to prepare it yourself at home: freeze your favorite berries or fruits and beat them with a blender until a homogeneous mass is obtained.

The calorie content of each meal should be approximately the same.

Make a menu so that the breakfast, lunch and dinner portions are equal in calories. Use the diabetic plate method: half the meal is vegetables and greens, one quarter carbohydrates, and another quarter meat/fish. It is best to contact a nutritionist to develop a personal nutrition plan.

Eat carbohydrates in the first half of the day.

For lunch: porridge, fruits, potatoes, milk. Carbohydrates have the highest glycemic index, so they can be consumed only before lunch, and after 5:00 p.m. carbohydrates are completely prohibited. This threatens a sugar spike at night, when it is not possible to control its level.

What you can’t eat with diabetes.

The list of prohibited foods for diabetes is honorably opened by alcohol; At the same time, the stronger the drink, the more calories it has. It should be abandoned completely.

In second place are easily digestible carbohydrates. They create a jump in blood glucose levels, which is dangerous in case of insulin deficiency. This includes all flour products (buns, white bread, cakes, pastries), soft wheat pasta, sweets with added sugar (soft drinks, chocolates, candies), sausages and sausages, potatoes, fast food. If it is not possible to exclude all these products from the diet, it is necessary to at least minimize their consumption.

It is also worth limiting:

Trans fats (margarine, store-bought pastries)

Cholesterol: optimally no more than 200 mg per day (approximately this amount is contained in 1 medium chicken egg)

Tinctures: approximately 1 teaspoon per day.

Saturated fats: animal products, fatty dairy products, coconut and palm oils.

You should not think that a couple of glasses of alcohol or some sweets will not affect anything, because even this amount can cause a jump in blood glucose and cause complications.

What can you eat with diabetes?

Problem with diabetes

Berries and fruits without sugar.

Low-fat dairy products

Beans

whole grain bread

Vegetables

Fish/lean meat

Eggs

What cereals are allowed to eat?

Barley (pearl, barley)

oat grains

Greek

Wheat

Quinoa

Rice (long grain brown rice only)

Meat or fish: what should be more in the diet.

Meat and fish are excellent sources of protein. But it is important to use them in moderation. It is impossible to say unequivocally what should prevail in the diet, it is only important not to abuse fatty varieties of meat / fish and include them in the menu in a measured manner.

What foods reduce the amount of sugar in the blood?

Fresh vegetables and herbs

Fruits and berries without sugar.

Seafood, sea fish

Avocado

Nuts of various varieties (almonds are the most useful)

Integral products

Beat the Clock, Beat Diabetes: How Breakfast Timing Influences Your Risk

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Breakfast Morning Art Concept

Research suggests that eating breakfast after 9 a.m. can significantly increase the risk of developing type 2 diabetes compared to an earlier breakfast. The study examined the eating patterns of over 100,000 participants, finding that meal timing affects the risk of diabetes, with a late breakfast adversely impacting glucose control and insulin levels.

A study that followed more than 100,000 participants for seven years suggests eating breakfast after 9 a.m. increases type 2 diabetes risk by 59%, highlighting the importance of meal timing in disease prevention.

Eating breakfast after 9 a.m. increases the risk of developing type 2 diabetes by 59% compared to people who eat breakfast before 8 a.m. This is the main conclusion of a study in which ISGlobal, an institution supported by “la Caixa” Foundation, took part and which followed more than 100,000 participants in a French cohort. The results show that we can reduce the risk of diabetes not only by changing what we eat, but also when we eat it.

The Impact of Meal Timing

Type 2 diabetes is associated with modifiable risk factors, such as an unhealthy diet, physical inactivity and smoking. But another factor may be important: the time at which we eat. “We know that meal timing plays a key role in regulating circadian rhythms and glucose and lipid control, but few studies have investigated the relationship between meal timing or fasting and type 2 diabetes,” says Anna Palomar-Cros, ISGlobal researcher and first author of the study.

In this study, a team from ISGlobal joined at team from INSERM in France to investigate the association between meal frequency and timing and the incidence of type 2 diabetes among 103,312 adults (79% women) from the French NutriNet-Santé cohort. Participants filled in online dietary records of what they ate and drank over a 24-hour period on 3 non-consecutive days, as well as the timing of their meals. The research team averaged the dietary records for the first two years of follow-up and assessed the participants’ health over the following years (an average of seven years).

Breakfast, Dinner, and Diabetes Incidence

There were 963 new cases of type 2 diabetes during the study. The risk of developing the disease was significantly higher in the group of people who regularly ate breakfast after 9 a.m., compared to those who ate breakfast before 8 a.m. “Biologically, this makes sense, as skipping breakfast is known to affect glucose and lipid control, as well as insulin levels,” explains Palomar-Cros. “This is consistent with two meta-analyses that conclude that skipping breakfast increases the risk of type 2 diabetes,” she adds.

The research team also found that a late dinner (after 10 p.m.) seemed to increase the risk, while eating more frequently (about five times a day) was associated with a lower disease incidence. In contrast, prolonged fasting is only beneficial if it is done by having an early breakfast (before 8 a.m.) and an early dinner.

Conclusions and Implications for Chrononutrition

“Our results suggest that a first meal before 8 a.m. and a last meal before 7 p.m. may help reduce the incidence of type 2 diabetes,” concludes Manolis Kogevinas, ISGlobal researcher and co-author of the study. In fact, the same ISGlobal team had already provided evidence on the association between an early dinner and a lower risk of breast or prostate cancer.
Taken together, these results consolidate the use of chrononutrition (i.e. the association between diet, circadian rhythms, and health) to prevent type 2 diabetes and other chronic diseases.

Pandemic Disruption Adversely Affected People With Diabetes

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For people with diabetes, disruption from the COVID-19 pandemic led to higher rates of death and other adverse outcomes, particularly diabetic ketoacidosis (DKA) in children, new research found.

The data came from what was believed to be the first systematic review of evidence related to the clinical impact of the disruptions caused by the COVID-19 pandemic and delays in seeking care among people with diabetes, rather than illness from the virus itself. The review was commissioned by the World Health Organization (WHO) and included a total of 138 studies. The majority (39 each) were from North America and Western Europe, but some were from Eastern Europe, Asia, South America, Australia, and Egypt. Overall, they included more than 100,000 people.

Despite a great deal of heterogeneity across the studies, there were some consistent patterns. Both all-cause and diabetes-related mortality were consistently increased during, compared to prior to, the pandemic, and most studies showed increases in major amputations and sight loss. While there were no differences in overall amputations or DKA in adults, there were significantly higher rates of DKA hospitalizations in children and adolescents, both with new-onset and preexisting type 1 diabetes.

The findings were published on January 23, 2024, in The Lancet Diabetes & Endocrinology by Jamie Hartmann-Boyce, PhD, of the Department of Health Promotion and Policy at the University of Massachusetts Amherst, and colleagues. The same team had conducted a previous similar WHO-commissioned review of the effects of the SARS-CoV-2 virus itself on people with diabetes.

‘It’s Important to Think About Who Is Most at Risk From These Disruptions’

The findings hold lessons for future pandemics or other types of emergency situations, Hartmann-Boyle told Medscape Medical News.

“It’s important to think about who is most at risk from these disruptions and targeting care to them. Also, just having plans in place for people for access to medications and supplies. In the US, it can be difficult to get backup supplies through insurance, but I think this tells us again how important that is, that there needs to be some sort of safety net.”

With children in particular, she advised, “keep in mind the warning signs to look out for in terms of new-onset diabetes and why it’s important not to wait to seek care.”

She cautioned that although the data came from around the world, most of the studies were done in higher-income areas. “There’s an inherent bias. These are people with access to healthcare. Our review is of evidence available globally, but the reality is that certain countries produce a lot more data than others.”

Even within the United States, “probably you’re getting people with more healthcare access and more socioeconomic advantage contributing their data to these studies than those struggling to access insulin, which was a problem before and during the pandemic.”

Several studies reported that people with type 1 diabetes with access to continuous glucose monitoring were likely to do well, or have even better A1c levels, during pandemic lockdown, whereas the opposite was true for those who didn’t. “We saw that technology really came in handy and helped a lot of people, but that can deepen already-existing inequalities,” she noted.

The Data: Deaths, DKA Were Consistent

Of six studies examining all-cause mortality among people with diabetes during the pandemic, just one excluded deaths due to COVID-19. That one found an increase in non-COVID–related deaths from 2019 to 2021 of 11%. The difference remained significant after adjustment for age, sex, socioeconomic deprivation, diabetes type, and other potential confounders. The mortality rates were higher among people who didn’t receive care processes during the pandemic.

Of 13 studies comparing diabetes-related mortality during 2020-2021 to pre-pandemic time periods, all found increases during vs prior. This increase was especially high, nearly threefold, among Hispanic individuals.

Four systematic reviews evaluated associations between the pandemic and DKA, of which three found 30%-40% increases in DKA and severe DKA among children with new-onset type 1 diabetes compared to before the pandemic.

“There are still ongoing questions about whether COVID increases the risk for new-onset diabetes. If new-onset type 1 diabetes is caught early on, it doesn’t result in DKA and ICU admission at diagnosis. But we know that during the pandemic, a lot of people waited until they were really sick before they sought medical care. I think that’s quite possibly part of the picture we’re seeing,” Hartmann-Boyle noted.

Among 12 studies of major amputations, nine showed a significant increase during the pandemic. However, the pattern was reversed for minor amputations, with three of four studies showing a decrease. Findings for diabetes-related hospitalizations in 30 studies were also mixed, with some showing increases and others decreases.

“It’s difficult to interpret the data on hospital admissions because we know that a lot of people were avoiding hospitals. So, how we interpret that is challenging. And the same goes for things like amputation and diabetic foot ulcer presentation. The studies that showed decreases in those, was it real or because they weren’t presenting at their doctors? It’s a challenge,” Hartmann-Boyle said.

As for vision, one systematic review found that delays in receipt of antivascular endothelial growth factor injections for various retinal diseases including diabetic vascular edema resulted in significant reductions in visual acuity across all diseases and specifically diabetic macular edema.

“The vision is a major concern. The studies suggested vision worsening more than we would have expected had there not been a pandemic. Anecdotally, eye screening rates really plummeted. If you have background retinopathy or preproliferative retinopathy, you’re not noticing that on a day-to-day basis, and it will only get picked up at screening. By the time you notice a change in your vision, you’ve lost the opportunity to intervene.”

Colchicine May Benefit Patients With Diabetes and Recent MI

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A daily low dose of colchicine significantly reduces ischemic cardiovascular events in patients with type 2 diabetes (T2D) and a recent myocardial infarction (MI). 

METHODOLOGY:

  • After an MI, patients with vs without T2D have a higher risk for another cardiovascular event.
  • The Cochicine Cardiovascular Outcomes Trial (COLCOT), a randomized, double-blinded trial, found a lower risk for ischemic cardiovascular events with 0.5 mg colchicine taken daily vs placebo, initiated within 30 days of an MI.
  • Researchers conducted a prespecified subgroup analysis of 959 adult patients with T2D (mean age, 62.4 years; 22.2% women) in COLCOT (462 patients in colchicine and 497 patients in placebo groups).
  • The primary efficacy endpoint was a composite of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization within a median 23 months.
  • The patients were taking a variety of appropriate medications, including aspirin and another antiplatelet agent and a statin (98%-99%) and metformin (75%-76%).

TAKEAWAY:

  • The risk for the primary endpoint was reduced by 35% in patients with T2D who received colchicine than in those who received placebo (hazard ratio, 0.65; P = .03).
  • The primary endpoint event rate per 100 patient-months was significantly lower in the colchicine group than in the placebo group (rate ratio, 0.53; P = .01).
  • The frequencies of adverse events were similar in both the treatment and placebo groups (14.6% and 12.8%, respectively; P = .41), with gastrointestinal adverse events being the most common.
  • In COLCOT, patients with T2D had a 1.86-fold higher risk for a primary endpoint cardiovascular event, but there was no significant difference in the primary endpoint between those with and without T2D on colchicine.

IN PRACTICE:

“Patients with both T2D and a recent MI derive a large benefit from inflammation-reducing therapy with colchicine,” the authors noted.

Diagnosis and Management of Diabetes-Related Foot Infections – 2023 Update

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An evidence-based, systematic approach to managing DFI.

Sponsoring Organizations: International Working Group on the Diabetic Foot; Infectious Diseases Society of America

Target Audience: Healthcare professionals involved in diabetes-associated footcare

Background

Incidence of diabetes-related foot infections (DFI) is increasing in parallel with the rising global prevalence of diabetes and is associated with significant morbidity and mortality. Recommendations were recently updated by the International Working Group on the Diabetic Foot/Infectious Diseases Society of America (IWGDF/IDSA) to guide the management and diagnosis of DFI.

Key Recommendations and Updates

  • Severity and diagnosis of DFI both depend on local and systemic symptoms.
  • Consider culturing tissue aseptically sampled by wound curettage or biopsy.
  • If plain x-rays and probe-to-bone testing are inconclusive for suspected osteomyelitis, magnetic resonance imaging should be performed.
  • Bone sampling (intraoperative or percutaneous) should be obtained for culture in osteomyelitis cases.
  • Antibiotics should be avoided in the absence of signs or symptoms of infection in diabetic foot ulcers.
  • For DFI involving skin and soft tissue, treatment duration is typically 1–2 weeks (up to 4 weeks if improvement is slow).
  • Empiric treatment should focus on gram-positive bacteria, including Staphylococcus aureus.
  • Empiric coverage of Pseudomonas aeruginosa is suggested for those living in Asia or North Africa.
  • In patients with DFI-associated osteomyelitis and amputation with positive bone margins, antibiotics are suggested for 3 weeks; for those patients without amputation, 6 weeks are recommended.
  • Surgical management should be considered in patients with moderate to severe DFI.
  • Adjunctive therapies (e.g., G-CSF, topical antiseptics, silver, honey, bacteriophages, topical antibiotics, hyperbaric oxygen) are not recommended.

Comment

Due to the dearth of clinical research focusing on management of DFI, most of these recommendations have relied on low-quality evidence or Best Practice statements. Nonetheless, these guidelines serve as a reminder to improve universal access to quality healthcare, given that DFI and ulcers often result from poorly managed diabetes — and once these complications occur, longitudinal multispecialty care will be needed.